This paper reports the findings of a descriptive study that examined the understanding and practice of public health nursing in one English NHS Region. Using questionnaires and focus groups, data were collected from nurses working in Health Authorities, senior Trust management, operational management and nursing practice across hospital and community services. The data were analysed using qualitative methods. The paper reports one aspect of the study, namely the views of the lead nurses in the Trusts and the Health Authorities regarding public health and nursing. The findings suggest that there are varying interpretations of public health nursing, lack of collaboration between and within organizations and disciplines and limitations in the knowledge and skills possessed by practitioners. It is argued that these issues all present barriers to the development of public health nursing and need to be considered as a matter of urgency if organizations and clinicians are to make the most of the current opportunities.
This article, the first in a three-part series on public health, promotes the case for community nurses to grasp the opportunities a public health approach to care offers to populations and communities. The importance of organisation and evaluation are emphasised as is the need for support from colleagues which, argue the authors, can only be obtained if the benefits of this approach are made clear. The second article in the series will appear next week.
Community-based personnel and NHS users are an under-used resource for medical education. Their proposed contributions strongly accord with the agenda for a population health perspective in basic training. Curriculum planners need to make long-term partnerships with community-based agencies, rather than using them as an intermittent provider of limited learning sessions with narrowly defined objectives.
1996 has been a year for celebrating the centenary of the Health Visitors Association. It has also been a time for reflecting on the history of the profession at a time of great uncertainty. This paper gives a historical account of the development of health visiting within an economic, political and social context. Drawing on original and contemporary texts the paper begins with the work of the early public health philanthropists and traces the development of health visiting through to the NHS reforms of the 1990s. Throughout the history of health visiting the voice of the user has been markedly absent, in particular the perspective of women. The history of health visiting reveals a number of themes that have preoccupied the profession and its observers since its inception: social control, confusion in understanding the role and scope of health visiting, medical domination and the tension between individualism and population approaches to public health. Today the profession has to fight to secure its position in a health service dominated by a bio-medical model. The challenge to prove their worth is one that the health visitors of today and tomorrow have to rise to if the profession is to survive in a world of resource constraint and evidence-based practice.
The increasing importance of primary care suggests an important role for the whole primary healthcare team in the education of 'tomorrow's doctors'. Few studies have evaluated the contribution and views of staff other than general practitioners. We used a questionnaire survey to elicit the perspective of 65 community-based nurses involved in a new undergraduate medical course. Some 67% of the cohort had already undertaken training to teach others, and were confident of their teaching skills but were overly reliant on the general practitioners for information, and on the goodwill of colleagues for time to teach. The findings suggest a need for structural changes in the process of multidisciplinary medical education, supporting the need for teaching commitments to be coordinated at practice rather than individual tutor level. The high level of professional development for teaching among community nurses suggests that there is a sound basis for encouraging such valuable professional input into medical education in the future.
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